2
Elise Anthony, Esq.
Steven Posnack, M.S., M.H.S.
Terrence O’Malley, MD
Have no real or apparent conflicts of interest to report.
Conflict of Interest
3
• Overview: connecting the dots. Policy, Payment, Technology
• The Building Blocks of Interoperability
– Business Case
– Governance
– Vocabularies
– Transport
– Repository of best available standards
• What’s new and what’s coming
Agenda
4
• Understand the importance of a compelling business case
• Know what this all means
– TEFCA
– DIRECT
– FHIR
– USCDI
– DEL
– ISA
• Learn the latest advances in
– Content
– Transport
– Governance
– Operational Standards
Learning Objectives
5
Tectonic Shift in Payment
5
Fee for Service
-Payment for each unit of
service. Produce
as many units as possible.
-No limit to number of units.
Revenue is variable.
-Time is money.
-Coordination and communication
are not priorities.
-Interoperability adds little value.
Value Based Payment
-Payment for each member of a
population unaffected by services
provided. Reduce total costs
-Revenue is fixed, savings are
variable.
-Time is savings.
-Coordination and
communication
are essential.
-Interoperability
improves
care.
6
Pick That Triangle!
6
Hospitals
Ambulatory
Care
Skilled
Nursing
Facilities
Home
Health Care
Community
Based
Services
Revenue
Cost of services
Time with patient
HIT Resources
Hospital
avoidance
Standardized
vocabulary
HIPAA
7
Pick a Dot, Any Dot
INTEROPERABILITY
Payment
Reform
HITECH
ACA
MACRA
ISA
TEFCA
USCDI
DEL
FHIR
21
st
Century
Cures
Act
IMPACT
Act
C-CDA
Workflow
8
• Elise Sweeney Anthony, JD
Executive Director, Office of Policy, ONC
Elise.Anthony@HHS.gov
• Steven Posnack, M.S., M.H.S.
Executive Director, Office of Technology, ONC
Steven.Posnack@HHS.gov
• Terrence A. O’Malley, MD
Physician, Massachusetts General Hospital,
Partners HealthCare
Tomalley@MGH.Harvard.edu
• Please complete the online session evaluation. Thank you.
Contact Information
9
Appendix
10
Spending is Unequally Distributed
11
Who are the Top and Pre-Top 5%?
• Individuals with complex medical, behavioral, functional and environmental
issues including adverse social determinants
• High utilization of emergency responders, emergency departments, hospitals,
nursing facilities, home nursing and home based services
• Care from multiple providers
• Care in multiple sites
• Multiple care transitions
• Need a longitudinal shared-care plan
April 10, 201811
